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        <p>5.临床上常用树脂的型号，优缺点等？颜色如何选择？<br>我能订到的复合树脂：<br>GC|光固化混合型纳米流体树脂<br>VOCO|歌兰迪欧光固化复合树脂<br>登士柏|Esthet.X flow流体树脂<br>贺利氏|卡瑞斯玛光固化复合树脂<br>科尔|琥珀通用树脂<br>可乐丽|SAC复合树脂|三支装<br>可乐丽|玛吉斯特光固化树脂<br>义获嘉|TetricN-C纳米瓷化树脂<br>3M|Z350 XT通用纳米树脂<br>3M|Valux光唯美固化复合树脂<br>VOCO|X-tra fil填压式后牙专用树脂<br>VOCO|波洛菲通用型高强度光固化树脂<br>3M|Z350 XT通用纳米树脂<br>科尔|光固化流动树脂<br>康特|Synergy D6纳米复合树脂<br>3M|Z250 XT光固化复合树脂<br>3M|P60光固化复合树脂<br>登士柏|CERAM-X瓷纳美树脂<br>临床我用的主要是3M的树脂，查查Z250,Z350,P60的区别和用途吧。<br>①<a target="_blank" rel="noopener" href="http://multimedia.3m.com/mws/media/862458O/filtek-z250xt.pdf?&fn=Filtek_Z250XT_TDS_6pg_A4_single_">Filtek Z250 XT通用复合树脂</a><br>光固化纳米复合树脂，前后牙通用。放射阻射性。<br>树脂的性能主要与填料有关。通常含有小颗粒填料的树脂相比大填料的树脂具有更好的耐磨性和抛光性。根据填料大小树脂主要分4类：微填料(Microfills），纳米填料(Nanofills），微混合填料(Microhybrids)，纳米混合填料（Nanohbrids)。<br>微填料：抛光性能很好，但是承担过重负载能力差，一般只用于轻咬合区域，如前牙。<br>纳米填料：3M ESPE是唯一拥有纳米填料产品的公司（真的吗？!）。Filtek Z350 XT是最新的纳米填料树脂，强度和美观性能的统一。<br>微混合填料和纳米混合填料：含有大颗粒和微米以下颗粒的混合。平均颗粒大小约为0.2-1微米。分布广泛的颗粒大小使其能承受咬合力。近来出现了纳米混合填料，二者之间的区别仍不明确。这能改善美学性能，然而，加入的纳米颗粒的数量是严格限制的。因此其对美学性能的改善是有限的。但是由于它们提供了很好的表现和灵活性，经常是在价格上，它们成为牙医的一个流行的选择。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0034-qb6-btszdxz/01.jpg"><br>本品还有表面改性的氧化锆和氧化硅颗粒。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0034-qb6-btszdxz/02.jpg"><br>客户反应：268位牙医在使用Z250复合树脂充填后3-5周进行评估，平均给了7.9分（满分10分）。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0034-qb6-btszdxz/03.jpg"><br>物理性能<br>压缩强度<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0034-qb6-btszdxz/04.jpg"><br>弯曲强度<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0034-qb6-btszdxz/05.jpg"><br>直径拉伸强度<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0034-qb6-btszdxz/06.jpg"><br>破碎强度<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0034-qb6-btszdxz/07.jpg"><br>体积收缩<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0034-qb6-btszdxz/08.jpg"><br>三体磨耗（？）<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0034-qb6-btszdxz/09.jpg"><br>6000次刷洗循环的耐磨性能<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0034-qb6-btszdxz/10.jpg"><br>Z350最好，其次就是Z250。<br>②<a target="_blank" rel="noopener" href="http://multimedia.3m.com/mws/media/631547O/filtek-z350-xt-technical-product-profile.pdf">Filtek Z350XT 通用充填系统</a><br>2002年推出Filtek系列复合树脂，是第一款应用纳米技术的树脂。2005年推出Filtek Supreme XT系列，主要在美观上改进。<br>Z350XT，前后牙通用复合树脂。放射阻射性。有牙本质色，牙体色，牙釉质色和透明色等。<br>适应症：<br>①前后牙直接充填（包括咬合面）。<br>②树脂堆核。<br>③树脂夹板。<br>④间接充填（包括树脂嵌体，树脂高嵌体，树脂贴面等）。<br>组成：由Z250改进而来，包括bis-GMA,UDMA,TEGDMA,以及bis-EMA等树脂成分，另外还有PEGDMA，TEGDMA等。 填料含有20nm的非团聚性的二氧化硅填料，非团聚性的4-11nm的氧化锆颗粒）。牙本质色，牙釉质色和牙体色（DEB）含有平均大小0.6-10微米的颗粒。透明色（T）含有平均大小0.6-20微米的颗粒。透明色的无机填料占重量的72.5%（占体积的55.6%），其它颜色的数据为78.%(63.3%）。<br>颜色系统：主要有四种，牙本质色（大部分不透明）、牙体色，牙釉质色和透明色（非常透明）。主要区别见图。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0034-qb6-btszdxz/11.jpg"><br>本-体-釉-透（DBET）的透明度依次上升。<br>提供的色号<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0034-qb6-btszdxz/12.jpg"><br>荧光性（Fluorescence)和乳光性(Opalescence）<br>与美学相关，分别指在紫外线区域(350-365nm)和可见光区域（400nm）光照时树脂发出的光。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0034-qb6-btszdxz/13.jpg"><br>颜色基本理论<br>彩度（Hue），是材料的真实颜色。以下显示从蓝到黄的颜色彩度。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0034-qb6-btszdxz/14.jpg"><br> VITAPAN色彩家族分类（Hue）<br>A系色    红-棕<br>B系色    红-黄<br>C系色    灰系色（值较低）<br>D系色    红-灰（值较低）<br>色度（Chroma）是颜色的强烈程度（intensity)。同一色族里数值越高（A3和A1相比），颜色的强度越高（ A3比A1强烈）。<br>亮度（value)，A,B族的值要更高（更白），C,D族的值要更低（更灰）。可以说，C族是A族的低值情况。亮度值通常是颜色最主要的方面。<br>研究显示人的牙齿颜色主要由牙本质决定。牙釉质层对颜色的影响很小。<br>对年轻患者，牙齿更量（更高的亮度），透明度更小。因为年龄因素，牙釉质层很薄，暴露更多的牙本质，牙齿呈现深色，尤其在龈1/3区域。<br>色度最强烈的区域是牙齿的龈方区域，因为这里牙釉质最薄，能透出更多的牙本质。<br>体部区域是混合着牙本质色和轻微的牙釉质色以及表面形态。文献建议体部的色度要比龈方区域的颜色低一两个等级。<br>切端区域因为牙本质的量的减少要，透明度要更高。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0034-qb6-btszdxz/15.jpg"><br>不透明性考量<br>牙釉质弥散并反射光，如果牙本质层很薄或者没有牙本质层（比如在切端），一些光会穿过牙齿到达口腔。口腔会通过釉质将光反射回来。<br>当光遇到牙本质，一些光被吸收，另一些通过牙釉质反射回来。<br>被反射回来的光进入眼睛就产生了牙齿的颜色。<br>牙齿的表面质地对感知颜色起了很重要的作用。比如更光滑的表面与粗糙的表面相比会更白（或更高的亮度）。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0034-qb6-btszdxz/16.jpg"><br>Z350XT树脂颜色选择技巧：①在清洁牙面以后，要先决定所用的树脂颜色，再进行牙体预备或者放置橡皮障。干燥的牙齿要比正常的牙齿更亮(lighter)。因此在干燥状态下的牙齿选用的色号要比湿润状态下的更亮。②在选择牙色时：如果选择使用一个颜色：选择牙体颜色来检查牙齿的中央部分。如果选择多于一个颜色来模拟牙齿的自然结构，增加最终充填体的活力，用色轮（Shade Wheel）来选择不透明度(opacity)。对给定的不透明度，决定所用的颜色的方法： a.选择牙本质色（或牙体色）来检查暴露的牙本质或龈方区域的颜色。选择最接近牙颈部区域的颜色；b.选择牙体色来检查牙齿中央；c.选择牙釉质色来检查切牙的近中和切端，或者后牙的牙尖区域；d.透明色用来表现较高的透明度以及增加充填体的“深度”。③在酸蚀以前进行mock-up。树脂的颜色与其厚度有关，树脂颜色在固化的时候可能会变化。在计划充填的区域恰当的放置树脂材料及其厚度，并就颜色与患者取得一致。用探针可以轻易取下mock-up。④在不同的光条件下评估比色和mock-up的结果。⑤在充填结束，充填体抛光的时候，模仿其邻牙的形态进行。<br>色轮的使用：没见过，pass。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0034-qb6-btszdxz/17.jpg"><br>Z350 XT的填料的改进：制造过程改进了，形成了团簇，更少的烧结。形成的不同大小范围的纳米团簇（nanoclusters）使其能承受更大的负荷。由于没有过多的烧结，形成的团簇大小范围可以很广，而不影响其它性质如耐磨性等。这些纳米团簇仍然有结构稳定性以提供强度，抗破裂性以及耐磨强度。在扫描电镜中，主要的纳米颗粒仍然是团簇样的，含有氧化锆/二氧化硅团簇，氧化锆和二氧化硅颗粒。为了达到高的透明度，透明树脂的制造过程稍微有一些不同。在原子力显微镜中，透明树脂也与其它树脂不同，表面粗糙程度更小。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0034-qb6-btszdxz/18.jpg"><br>物理性质<br>耐磨性（用刷牙实验检测）<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0034-qb6-btszdxz/19.jpg"><br>Z350XT的透明色树脂最好，其次是Z350XT的其它色树脂。<br>与其它品牌相比，有的随着实验次数的增加下降得很快。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0034-qb6-btszdxz/20.jpg"><br>Wyko图像，也是表面图像，比原子力显微镜那个范围更广。看表面粗糙度的。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0034-qb6-btszdxz/21.jpg"><br>一些竞品的，TPH是我以前最爱用的树脂，因为便宜……<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0034-qb6-btszdxz/22.jpg"><br>破碎强度(Fracture Toughness)<br>用如图的方法测试<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0034-qb6-btszdxz/23.jpg"><br>实验结果<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0034-qb6-btszdxz/24.jpg"><br>Z350XT的破碎强度与微填料树脂的差异有统计学意义。<br>径向拉伸强度（Compressive and Diametral Tensile Strength）<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0034-qb6-btszdxz/25.jpg"><br>实验结果<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0034-qb6-btszdxz/26.jpg"><br>都差不多。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0034-qb6-btszdxz/27.jpg"><br>弯曲强度（Flexural Strength and Modulus)<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0034-qb6-btszdxz/28.jpg"><br>其它数据略了。<br>③<a target="_blank" rel="noopener" href="http://multimedia.3m.com/mws/media/825180O/espepdf.pdf">P60复合树脂</a><br>色号：A3、B2、C2<br>用于后牙修复，填料是氧化锆/ 硅胶。该无机填料的载荷体积比为61%（无硅烷处理），颗粒度范围在0.01-3.5微米之间。<br>适应症：<br>后牙直接修复<br>桩核制作<br>夹板<br>间接修复，包括嵌体、高嵌体和贴面。<br>含有甲基丙烯酸树脂，有过敏现象，避免未固化树脂与皮肤接触。<br>充填：逐层充填，每层不得超过2.5mm。注意事项：①为做好充填，第一层可为1mm，敷满内壁；②工作区避免强光照射；③可使用压缩装置把树脂材料更好地结合到窝洞内壁所有地方；光固化20s。抛光，用Sof-Lex。<br>④<a target="_blank" rel="noopener" href="http://solutions.3m.com.cn/3MContentRetrievalAPI/BlobServlet?lmd=1359360035000&locale=zh_CN&assetType=MMM_Image&assetId=1319246415318&blobAttribute=ImageFile">3M流动树脂</a><br>低粘度、可见光固化的，X线阻射的流动型纳米树脂。填料组成：0.1-5.0微米的三氟化钇，20nm的无团聚/非聚集型表面改良硅填料、70nm的无团聚/非聚集型表面改良硅填料，表面改良的非聚集型氧化锆/硅微孢填料（包含20nm的硅和4到11nm的氧化锆粒子）。团块颗粒平均大小为0.6微米到10微米。<br>适应症：Ⅲ类和Ⅴ类洞的修复；微创窝洞预备修复（包括小的，非承力咬合部位的修复）；美学间接修复体小缺陷的修复；直接修复的垫底/衬层；窝洞封闭；填补倒凹；树脂和丙烯酸临时材料的修补。<br>充填后为避免树脂材料从注射头中泄漏出来，可将注射活塞向后拉。<br>固化时间<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0034-qb6-btszdxz/29.jpg"><br>衬洞/基底材料应用：在固化的流动树脂上直接涂抹复合树脂材料，按说明书使用。<br>精修抛光，用Sof-Lex精修和抛光系统进行抛光，或在抛光碟不适用的地方用白色磨石、橡胶尖或抛光膏进行抛光。</p>
<p>比较一下成本吧。(来源：爱牙库）<br>Z250 XT 105元<br>Z350 XT 180元<br>P60        165元<br>所以收费应该是Z250最便宜，P60中档，Z350最贵，但是P60只能用于后牙，所以前牙中档也用Z350吧。<br>Z250和Z350是纳米混合材料，P60是微填料。<br>补充一个3M树脂选择方案<br><a target="_blank" rel="noopener" href="https://www.aiyaku.com/product/content/201506/988.html?secondLevelSource=%E5%95%86%E5%93%81%E5%88%97%E8%A1%A8%E9%A1%B5">https://www.aiyaku.com/product/content/201506/988.html?secondLevelSource=%E5%95%86%E5%93%81%E5%88%97%E8%A1%A8%E9%A1%B5</a><br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0034-qb6-btszdxz/30.jpg"><br>比色的问题，下次再写吧。</p>
<p>我发文章的三个地方，欢迎大家在朋友圈等地方分享，欢迎点“在看”。<br>我的个人博客地址：<a href="https://zwdnet.github.io/">https://zwdnet.github.io</a><br>我的知乎文章地址： <a target="_blank" rel="noopener" href="https://www.zhihu.com/people/zhao-you-min/posts">https://www.zhihu.com/people/zhao-you-min/posts</a><br>我的微信个人订阅号：赵瑜敏的口腔医学学习园地<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/other/wx.jpg"></p>

      
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